Who is a dual eligible in Arizona?
AHCCCS (the Arizona Health Care Cost Containment System, said "access") is Arizona's Medicaid program. AHCCCS calls its members who also have Medicare "dual eligible members." Being dual eligible does not mean one kind of coverage. What you get depends on which AHCCCS program you qualify for:
| Type | AHCCCS program | What AHCCCS does |
|---|---|---|
| Full dual | Full AHCCCS coverage, for example SSI-related coverage for people 65 or older, blind or disabled, or ALTCS | Pays Medicare premiums and cost sharing, and covers AHCCCS services Medicare doesn't, such as long-term care for ALTCS members |
| Partial dual (QMB) | Qualified Medicare Beneficiary, a Medicare Savings Program | Pays Part A and Part B premiums, deductibles and coinsurance |
| Partial dual (SLMB or QI-1) | Specified Low-Income Medicare Beneficiary or Qualified Individual-1 | Pays the Part B premium only |
The Medicare Savings Programs have their own income limits and, in Arizona, no resource test. See Medicare Savings Programs in Arizona for the rules.
How AHCCCS and Medicare work together
Medicare is always your primary coverage. Doctors and hospitals bill Medicare (or your Medicare plan) first, and AHCCCS pays after Medicare for costs and services it covers. A few rules matter in daily life:
- Prescription drugs come from Medicare. Once you have Medicare, your drugs are covered through a Medicare Part D plan or a Medicare plan with drug coverage, not through AHCCCS. Anyone with full AHCCCS coverage or a Medicare Savings Program gets Extra Help automatically, which lowers Part D costs to small copays (no more than $5.10 for a generic and $12.65 for a brand-name drug in 2026, and less for many full duals).
- The Part B premium is paid for you. AHCCCS pays your Part B premium ($202.90 a month in 2026) under every program in the table above, so it is no longer taken out of your Social Security check.
- QMB protects you from Medicare bills. If you are a QMB, doctors and other providers who accept Medicare may not bill you for Medicare deductibles, coinsurance or copays. Show both your Medicare card and your AHCCCS card at every visit.
- Keep your AHCCCS renewal current. If AHCCCS coverage stops, so does the help with Medicare costs, and you could lose eligibility for a D-SNP.
Your Medicare choices as an AHCCCS member
AHCCCS describes three ways dual eligible members can get their Medicare benefits:
- Original Medicare with a standalone Part D drug plan.
- A dual special needs plan (D-SNP), a type of Medicare Advantage plan that contracts with AHCCCS and is available only to people who have both Medicare and AHCCCS.
- Another Medicare Advantage plan open to anyone with Medicare in your county.
For 2027, CMS data show 57 special needs plans in Arizona, counting every type of special needs plan, not only D-SNPs. Which ones you can join depends on your county and your AHCCCS program.
How Arizona aligns D-SNPs with AHCCCS plans
Being in a Medicare plan and an AHCCCS plan run by the same company is what AHCCCS calls alignment. AHCCCS says alignment gives you one plan that coordinates your care, and for ALTCS members one member ID card and one customer service number for both programs. Arizona builds alignment into its contracts:
- AHCCCS Complete Care (ACC). Each ACC health plan must offer a partner Medicare D-SNP, so members can choose to get Medicare and AHCCCS from the same company. Joining the partner D-SNP is your choice; AHCCCS does not move ACC members automatically.
- ALTCS for the elderly and physically disabled (ALTCS-EPD). Since January 1, 2025, Arizona uses exclusively aligned enrollment: if you are in ALTCS-EPD and choose a D-SNP that has a companion ALTCS-EPD plan from the same parent company, AHCCCS changes your ALTCS-EPD plan to match. If you pick any other Medicare plan, your ALTCS-EPD plan stays the same. The Medicare plan you choose drives the change, not the other way around.
- Tribal ALTCS and the Division of Developmental Disabilities. AHCCCS's alignment rules work differently for members served by a Tribal ALTCS program, and members served through ALTCS-DDD are not part of the ALTCS-EPD alignment. Ask your case manager before changing your Medicare plan.
Tip: To find out whether your Medicare and AHCCCS plans are aligned, AHCCCS suggests calling the Member Services number on your AHCCCS health plan ID card.
When you can change your Medicare coverage
Dual eligibles have more chances to change than most people with Medicare. Besides the Annual Enrollment Period (October 15 to December 7, for coverage starting January 1, 2027), two special enrollment periods apply:
- Once a month, anyone with AHCCCS or Extra Help can switch to Original Medicare with a standalone drug plan, or change standalone drug plans.
- Once a month, people with full AHCCCS coverage can join or switch to an integrated D-SNP, a D-SNP that is aligned with their AHCCCS plan.
Changes take effect the first day of the next month. If you are in ALTCS-EPD, remember that choosing a D-SNP with a companion ALTCS-EPD plan also changes your ALTCS-EPD plan.
ALTCS: Arizona's long-term care program
The Arizona Long Term Care System (ALTCS) is the part of AHCCCS that pays for long-term care. Medicare covers only short stays in a skilled nursing facility after a qualifying hospital stay and part-time skilled home health care, not ongoing help with daily activities. For many Arizonans, ALTCS is how long-term care gets paid for.
Who qualifies
ALTCS has its own application, and you must pass two tests:
- Financial. Your monthly income must be at or below 300% of the SSI federal benefit rate (the maximum monthly SSI payment for one person, which Social Security sets each year). ALTCS also has a resource limit for countable assets such as bank accounts. If you have a spouse who still lives at home, AHCCCS sets aside part of the couple's resources for that spouse. Some members pay a monthly share of cost toward their care. AHCCCS publishes the current dollar amounts in its eligibility requirements chart.
- Medical and functional. A nurse or social worker completes a Pre-Admission Screening (PAS) to decide whether you need a nursing-facility level of care. For older adults and people with physical disabilities, the screening looks at daily activities such as moving around, transferring, bathing, dressing, eating and toileting, along with medical conditions.
Most older adults who qualify are served through ALTCS-EPD (elderly and physically disabled), which covers people who are 65 or older, blind or disabled. People with intellectual or developmental disabilities are served through the Division of Developmental Disabilities (ALTCS-DDD).
What ALTCS covers
ALTCS members get AHCCCS medical services plus long-term care. AHCCCS lists these among its ALTCS services:
At home
Attendant care, home health services (nursing, home health aide, therapy), home delivered meals, and case management. Members living in their own home can choose options to direct their own caregivers.
In the community
Adult day health services, so a family caregiver can work or rest while their relative is cared for during the day.
Residential care
Assisted living facilities and nursing facilities, plus hospice care.
These home and community based services let many ALTCS members stay in their own homes or in assisted living instead of moving to a nursing facility.
ALTCS and your Medicare
ALTCS does not replace Medicare. Medicare still pays first for hospital stays, doctor visits, short skilled nursing stays and home health it covers, and your drugs still come from Medicare Part D. ALTCS pays your Medicare premiums and cost sharing and covers the long-term care Medicare does not. If you are in ALTCS-EPD, the D-SNP alignment rules above apply when you choose a Medicare plan.
Estate recovery
To enroll in ALTCS, you acknowledge that AHCCCS may recover the cost of your care from your estate after you die. Under the AHCCCS estate recovery program, this applies to members who received ALTCS nursing facility or home and community based services when they were 55 or older (for services on or after January 1, 1994). Federal law requires the state to wait while a surviving spouse is living, or while there is a surviving child under 21 or a child of any age who is blind or disabled. If estate planning is a concern, talk with an attorney before you apply.
How to apply in Arizona
AHCCCS and Medicare Savings Programs
Apply online at Health-e-Arizona Plus, call 1-855-HEA-PLUS (1-855-432-7587), or visit a DES Family Assistance Office. You can also mail an application to AHCCCS.
ALTCS
Register an ALTCS application in Health-e-Arizona Plus, or call ALTCS toll-free at 1-888-621-6880. AHCCCS has ALTCS offices in Chinle, Flagstaff, Kingman, Phoenix, Tucson and Yuma.
Medicare
Medicare enrollment goes through Social Security (1-800-772-1213, TTY 1-800-325-0778). Questions about Medicare coverage: 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).
More numbers are on our Arizona Medicare contacts page.
Help choosing a Medicare plan
AHCCCS decides whether you qualify for AHCCCS and ALTCS. Benefits Life is not part of AHCCCS and cannot approve an application. Once you know your AHCCCS program, a licensed insurance agent with Benefits Life can explain the D-SNPs and other Medicare plans from the companies they work with in your county, and how a plan choice would affect your AHCCCS or ALTCS-EPD plan, at no cost to you. Call (602) SENIORS (602-736-4677), TTY 711, or see plans in your ZIP code.
Sources
- AHCCCS — Eligibility Requirements (effective February 1, 2026)
- AHCCCS Office of Individual and Family Affairs — Dual Eligible Members (December 2024)
- AHCCCS — Dual Eligible Members and D-SNPs
- AHCCCS — ALTCS-EPD and Medicare D-SNP Exclusively Aligned Enrollment FAQ (rev. November 29, 2024)
- AHCCCS — Arizona Long Term Care System (ALTCS) offices and how to apply
- AHCCCS — Covered services
- AHCCCS Eligibility Policy Manual — Preadmission Screening criteria for an applicant who is EPD
- AHCCCS Eligibility Policy Manual — Estate Recovery Program overview
- Medicare.gov — Special Enrollment Periods
- Medicare.gov — Help with drug costs (Extra Help)
- eCFR — 42 CFR 423.38, enrollment periods
Frequently asked questions
What is the difference between a full dual and a partial dual in Arizona?
A full dual has Medicare and full AHCCCS coverage, such as AHCCCS for people 65 or older or with a disability, or ALTCS. A partial dual has Medicare and only a Medicare Savings Program (QMB, SLMB or QI-1), where AHCCCS helps with Medicare premiums and, for QMB, Medicare cost sharing, but does not provide other Medicaid services.
Does AHCCCS replace Medicare?
No. Medicare stays your main coverage and pays first. AHCCCS pays after Medicare for costs and services it covers, and your prescription drugs come through a Medicare Part D plan or a Medicare plan with drug coverage, with Extra Help lowering the cost.
What is ALTCS?
The Arizona Long Term Care System (ALTCS) is the part of AHCCCS that pays for long-term care in a nursing facility, an assisted living facility or your own home. You must meet financial limits and a medical and functional screening that shows you need a nursing-facility level of care.
If I join a D-SNP, will my AHCCCS plan change?
It can. Since January 1, 2025, if you are in ALTCS for the elderly and physically disabled (ALTCS-EPD) and you pick a D-SNP that has a companion ALTCS-EPD plan from the same company, AHCCCS moves your ALTCS-EPD enrollment to that companion plan. Members of AHCCCS Complete Care are not moved automatically, but each AHCCCS Complete Care plan offers a partner D-SNP.
Where do I apply for AHCCCS or ALTCS?
Apply for AHCCCS and the Medicare Savings Programs online at Health-e-Arizona Plus (healthearizonaplus.gov) or by calling 1-855-HEA-PLUS (1-855-432-7587). For ALTCS, register an application in Health-e-Arizona Plus or call the ALTCS line at 1-888-621-6880.
